| Objective: To retrospectively explore the characteristics of TCM syndrome type,syndrome element characteristics of Pseudomonas aeruginosa pneumonia and the risk factors of severe diseaseMethod: Selected patients whose sputum culture results were Pseudomonas aeruginosa in the microbiology room of Frist Teaching Hospital of Tianjin University of Traditional Chinese Medicine from 2015.01.01 to 2021.02.01,then exported their medical record number and selected patients who diagnosed with Pseudomonas aeruginosa pneumonia during hospitalization.A medical record information collection form was developed to collect general patient information(name,gender,age,case number,admission date,hospital department,smoking history,drinking history),information related to the course of the disease(whether or not turned into a severe disease,time from the onset of pneumonia to the onset of severe disease,time from the onset of pneumonia to the recovery of the disease),clinical signs(temperature,respiration,blood pressure,pulse),basic diseases(whether or not the patient had chronic obstructive pulmonary disease,chronic cardiac insufficiency,cerebral infarction,hypertension,type 2 diabetes mellitus,chronic renal insufficiency),TCM symptoms(fever,chills,sweating,cough,sputum quality,sputum color,hemoptysis,thirst,chest pain,shortness of breath,tongue color,moss color,moss quality,pulse),diagnosis of TCM syndrome type,laboratory tests(white blood cell count,neutrophil count,hemoglobin,albumin,C-reactive protein,calcitoninogen,endotoxin),and imaging tests.The cases were divided into two groups: non severe group and severe group.The characteristics of TCM Syndrome types and syndrome elements of patients with Pseudomonas aeruginosa pneumonia were summarized,and the risk factors of patients with Pseudomonas aeruginosa pneumonia turning into severe were explored by Cox single factor and multi factor analysis.Results: There were 244 patients who met the inclusion/exclusion criteria,201 non severe patients and 43 severe patients,with a severe rate of about 17.6%.There were 186 males and 58 females,with a male to female ratio of 3.21:1.The overall average age was70.42 ± 13.04 years,including 69.48 ± 13.25 years in the non severe group and 74.84 ± 11.14 years in the severe group.The comparison between two groups showed that the age and smoking rate in the severe group were higher than those in the non severe group(P < 0.05).The basic diseases and operations with frequencies above 50% were hypoproteinemia(77.5%),gastric catheter placement(72.5%),hypertension(65.6%),anemia(60.7%),and cerebral infarction(58.6%).The comparison between two groups showed that the rate of gastric catheterization and the prevalence rate of chronic cardiac insufficiency in the severe group were higher than those in the non severe group(P < 0.05).The average value of serum albumin was 31.54 ± 4.56g/l.The average value of hemoglobin was 111.72 ± 23.00g/l for men and 101.88 ± 22.16g/l for women.The Department of acupuncture and moxibustion and emergency are the main inpatient department.Cluster analysis of TCM syndromes related to pneumonia in patients with Pseudomonas aeruginosa pneumonia showed that there were three syndrome types: phlegm heat blocking the lung,phlegm turbidity blocking the lung and lung spleen qi deficiency;According to the calculation of TCM syndrome elements,a total of 22 syndrome elements are obtained,including 8 disease location syndrome elements and 14 disease syndrome elements.The common disease location syndrome elements are lung,brain,liver,kidney and spleen,and the common disease syndrome elements are phlegm,yin deficiency,heat,Qi deficiency,blood stasis,Yin,qi stagnation,yang hyperactivity and dampness.Cox univariate survival analysis showed that advanced age(P = 0.004),chronic cardiac insufficiency(P = 0.041),gastric catheterization(P = 0.048),yin deficiency(P =0.047),location of the disease in the kidney(P = 0.012),blood stasis(P = 0.027),Yin(P =0.028)and location of the disease in the spleen(P = 0.007)were related to the severe cases of Pseudomonas aeruginosa pneumonia.Multivariate analysis of the above risk factors(Cox risk proportional regression model)showed that advanced age(HR = 3.074;95% CI: 1.517-6.228;P = 0.002),gastric catheterization(HR = 4.520;95% CI: 1.626-12.565;P = 0.004),location of the disease in the kidney(HR = 2.714;95% CI: 1.128-6.534;P = 0.026),blood stasis(HR =2.847;95% CI: 1.389-5.834;P = 0.004)Yin(HR = 2.572;95% CI: 1.174-5.635;P = 0.018)and location of the disease in the spleen(HR = 4.365;95% CI: 1.790-10.643;P = 0.001)were independent risk factors for severe Pseudomonas aeruginosa pneumonia.Conclusion: The TCM syndrome types of patients with Pseudomonas aeruginosa pneumonia are mainly phlegm heat blocking the lung,phlegm turbidity blocking the lung and lung spleen qi deficiency.The disease location syndrome elements of patients with Pseudomonas aeruginosa pneumonia are mainly in the lung,which are closely related to the brain,liver,kidney and spleen.The common disease syndrome elements are phlegm,yin deficiency,heat,Qi deficiency,blood stasis,Yin,qi stagnation,yang hyperactivity and dampness.In TCM syndrome elements,the location of the disease in the kidney increases the risk of severe disease by 1.714 times,blood stasis increases the risk of severe disease by1.847 times,drinking increases the risk of severe disease by 1.572 times,and the location of the disease in the spleen increases the risk of severe disease by 3.365 times,all of which are independent risk factors for patients with severe Pseudomonas aeruginosa pneumonia.In addition,advanced age and gastric catheterization are also independent risk factors for severe Pseudomonas aeruginosa pneumonia. |
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